Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Fontana Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES K HILGER (CHIEF ACCOUNTING OFFICER)
(253) 733-4500
Entity
Organization
Contact information
Practice address
17590 FOOTHILL BLVD, FONTANA, CA 92335-3785
(909) 356-9664
(909) 356-9687
Mailing address
5200 VIRGINIA WAY, L&C DEPT 4TH FL, BRENTWOOD, TN 37027-7569
(615) 341-6765
(833) 782-9089
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
240000334
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326012311
—
CA
Enumeration date
02/15/2006
Last updated
04/16/2019
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